A Multicenter Comparison of Prevalence and Predictors of Antimicrobial Resistance in Hospitalized Patients Before and During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic

Karri A Bauer; Laura A Puzniak; Kalvin C Yu; Kenneth P Klinker; Janet A Watts; Pamela A Moise; Lyn Finelli; ChinEn Ai; Vikas Gupta

doi:10.1093/ofid/ofac537

A Multicenter Comparison of Prevalence and Predictors of Antimicrobial Resistance in Hospitalized Patients Before and During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic

Open Forum Infect Dis. 2022 Oct 17;9(11):ofac537. doi: 10.1093/ofid/ofac537. eCollection 2022 Nov.

Authors

Karri A Bauer¹, Laura A Puzniak¹, Kalvin C Yu², Kenneth P Klinker¹, Janet A Watts², Pamela A Moise¹, Lyn Finelli¹, ChinEn Ai², Vikas Gupta²

Affiliations

¹ Merck & Co, Inc, Rahway, New Jersey, USA.
² Becton, Dickinson & Company, Franklin Lakes, New Jersey, USA.

Abstract

Background: Antibacterial therapy is frequently used in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) without evidence of bacterial infection, prompting concerns about increased antimicrobial resistance (AMR). We evaluated trends in AMR before and during the SARS-CoV-2 pandemic.

Methods: This multicenter, retrospective cohort analysis included hospitalized adults aged ≥18 years with >1-day inpatient admission and a record of discharge or death from 271 US facilities in the BD Insights Research Database. We evaluated rates of AMR events, defined as positive cultures for select gram-negative and gram-positive pathogens from any source, with nonsusceptibility reported by commercial panels before (1 July 2019-29 February 2020) and during (1 March 2020-30 October 2021) the SARS-CoV-2 pandemic.

Results: Of 5 518 666 admissions evaluated, AMR rates per 1000 admissions were 35.4 for the prepandemic period and 34.7 for the pandemic period (P ≤ .0001). In the pandemic period, AMR rates per 1000 admissions were 49.2 for SARS-CoV-2-positive admissions, 41.1 for SARS-CoV-2-negative admissions, and 25.7 for patients untested (P ≤ .0001). AMR rates per 1000 admissions among community-onset infections during the pandemic were lower versus prepandemic levels (26.1 vs 27.6; P < .0001), whereas AMR rates for hospital-onset infections were higher (8.6 vs 7.7; P < .0001), driven largely by SARS-CoV-2-positive admissions (21.8). AMR rates were associated with overall antimicrobial use, rates of positive cultures, and higher use of inadequate empiric therapy.

Conclusions: Although overall AMR rates did not substantially increase from prepandemic levels, patients tested for SARS-CoV-2 infection had a significantly higher rate of AMR and hospital-onset infections. Antimicrobial and diagnostic stewardship is key to identifying this high-risk AMR population.

Keywords: COVID-19; antibiotics; antimicrobial resistance; antimicrobial stewardship; nosocomial infections.